Shoulder dystocia in a Jamaican cohort.
OBJECTIVE
To assess the risk factors for shoulder dystocia in Jamaica.


METHODS
A retrospective cohort analysis of all cases of shoulder dystocia, and birth weight-matched controls identified from January 1, 2000 to December 31, 2004. Multiple factors were analyzed individually and in combination to identify risk factors.


RESULTS
The incidence of shoulder dystocia was 0.83%. Nulliparity, a first stage of labor greater than 7 hours, a second stage lasting more than 1 hour, and use of oxytocin augmentation were found to be statistically significant factors with unadjusted odds ratios (95% confidence interval) of 1.78 (0.86-3.34), 1.89 (0.91-3.94), 2.78 (0.24-31.47), and 1.56 (0.77-3.15), respectively. The incidence of shoulder dystocia decreased as parity increased when adjusted for age.


CONCLUSIONS
Individual risk factors for shoulder dystocia remain obscure. The nulliparous pelvis, when controlled for neonatal weight, was associated with a statistically increased risk of shoulder dystocia; this risk decreased with increasing parity.
Christie
Loxley R
LR
Department of Obstetrics and Gynecology, University Hospital of the West Indies, Kingston, Jamaica. loxleychristie@hotmail.com
Harriott
John A
JA
Mitchell
Sharmaine Y
SY
Fletcher
Horace M
HM
Bambury
Ian G
IG
D000328:Adult; D004420:Dystocia / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005320:Fetal Macrosomia; D006785:Hospitals, University; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012782:Shoulder